Exploring Patients' Perceptions of an Advance Care Planning Intervention in the Emergency Department: A Qualitative Study.

IF 3.2 3区医学 Q1 EMERGENCY MEDICINE

Academic Emergency Medicine Pub Date : 2025-07-29 DOI:10.1111/acem.70109

Youkie Shiozawa, Saaya Morton, Nanako Shirai, Hannah Oelschlager, Lucy Kiernat, Anita N Chary, Anna C Revette, Adrian Haimovich, Smit Desai, Kai-Wei Chang, Shan W Liu, Maura Kennedy, Mara A Schonberg, Kei Ouchi

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引用次数: 0

Abstract

Objectives: Emergency department (ED) visits offer opportunities for seriously ill patients to formulate future medical care goals, yet ED clinicians lack practical strategies for these conversations. ED GOAL, a behavioral intervention, engages seriously ill yet clinically stable older adults in the ED to address advance care planning (ACP) with their outpatient clinicians. In a randomized trial, goals-of-care documentation was significantly higher in the intervention group compared to controls after three (24.3% vs. 9.9%, p = 0.03) and 6 months (31.4% vs. 12.7%, p < 0.01). This study is a sub-analysis to learn about intervention arm participants' perceived benefits and obstacles of the intervention.

Methods: We conducted semi-structured interviews between October 2022 and August 2024 (N = 52) with intervention-arm patients aged 50+ years at three hospitals in Boston, Massachusetts. Using rapid qualitative analyses, we identified themes in intervention-arm participants' comments to open-ended questions about the intervention's benefits and obstacles to continue ACP outside the ED.

Results: Of 70 intervention-arm participants, 52 completed interviews, of which two were surrogates. ED GOAL motivated most patients to initiate ACP with outpatient clinicians and loved ones and improved the quality of conversations by clarifying patients' wishes and improving patient-clinician relations. Barriers to continuing ACP were the lack of clinician availability and patient/surrogate readiness. Those with clear care goals found the intervention less useful yet harmless.

Conclusions: The intervention provided participants with insights into actionable ACP steps. To address the lack of clinician availability, these conversations may be completed by non-physician clinicians or through non-personnel resources. Better tailored ACP interventions may improve patients' readiness.

Trial registration: ClinicalTrials.gov identifier: NCT05209880.

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探索急诊科患者对预先护理计划干预的看法：一项定性研究。

目的：急诊科（ED）访问为重病患者提供了制定未来医疗保健目标的机会，但急诊科临床医生缺乏这些对话的实用策略。ED GOAL是一种行为干预，针对急诊科中病情严重但临床稳定的老年人，与门诊医生一起制定提前护理计划（ACP）。在一项随机试验中，干预组在3个月（24.3%对9.9%,p = 0.03）和6个月（31.4%对12.7%,p）后的护理目标记录显著高于对照组。方法：我们在2022年10月至2024年8月（N = 52）期间对马萨诸塞州波士顿三家医院的50岁以上干预组患者进行了半结构化访谈。通过快速定性分析，我们确定了干预组参与者对开放式问题的评论主题，这些问题涉及干预的益处和在ed之外继续ACP的障碍。结果：在70名干预组参与者中，52人完成了访谈，其中2人是代理人。ED GOAL激励大多数患者与门诊临床医生和亲人开始ACP，并通过澄清患者的意愿和改善医患关系来提高对话质量。继续ACP的障碍是缺乏临床医生的可用性和患者/代理人的准备。那些有明确护理目标的人发现干预作用不大，但无害。结论：干预为参与者提供了可操作的ACP步骤的见解。为了解决缺乏临床医生可用性的问题，这些对话可以由非医师临床医生或通过非人员资源完成。更有针对性的ACP干预可能会提高患者的准备程度。试验注册：ClinicalTrials.gov标识符：NCT05209880。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Emergency Medicine 医学-急救医学

CiteScore

7.60

自引率

6.80%

发文量

207

审稿时长

3-8 weeks

期刊介绍： Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.